Professionals without proper training are deciding whether suspected criminals in the District are competent to stand trial and patients are being unnecessarily held at the public psychiatric hospital, according to a report released Monday.

The 191-page report, by the nonprofit Council for Court Excellence and the D.C. auditor, examined the way the city’s Department of Behavioral Health handles defendants suspected of being mentally ill. The authors presented their findings Monday at an oversight hearing of the D.C. Council.

The reviewfound the department fell short in its basic obligation to evaluate the mental fitness of defendants. It said the department should do more to make sure they get treatment and resources such as housing to help them stay out of the criminal justice system.

“There’s this revolving door of incarceration, treatment and relapse and reincarceration for ­often minor and nonviolent offenses,” said Michael D. Hays, a lawyer who co-chaired the report committee. “The costs in human misery and economic costs to D.C. government are substantial.”

The report suggests ways to address what it described as systemic and structural problems. Recommendations include increasing funding for mental health providers and mandating specialized training to evaluate defendants.

Exterior view of St. Elizabeth's Hospital, on April, 14, 2016 in Washington, DC.

The report also urged Mayor Muriel E. Bowser (D) to scrutinize the leadership of Department of Behavioral Health Director Tanya Royster, whom the mayor appointed in 2015, and Nicole Johnson, who oversaw forensic psychologists who evaluate defendants but has since moved to a different role.

Morale was low after changes that left the agency run by managers hostile to constructive feedback and aggressive toward patients, according to government employees interviewed by the report’s authors.

In a formal response to the report, Royster acknowledged room for improvement and agreed with many of the report’s recommendations. But concerns about her leadership were based on “hearsay and innuendo,” Royster wrote.

At the council oversight hearing, lawmakers said the report raised grave concerns about the state of the mental health system.

“This is the kind of thing you can’t just ignore and hope it goes away,” council member David Grosso (I-At Large) said. “It has not gotten better. It’s gotten worse.”

Royster told lawmakers that her agency needs help from a variety of partners, especially since federal authorities have unusual influence over the District’s criminal justice system in prosecuting local crime and imprisoning offenders.

“Our goal is that whenever appropriate, people with mental illnesses or addiction should have the opportunity for treatment, not incarceration,” Royster said. “I welcome the chance for a public discussion of how we as a community can best support people with behavioral health challenges.”

The report and council hearing follow a series of scandals dogging the Department of Behavioral Health.

In recent months, D.C. judges have criticized the agency for failing to examine defendants in a timely manner, creating a backlog of people in jail who should be in treatment.

While that wait list for mental health evaluations has been cleared, it involved a reshuffling at St. Elizabeths, the public psychiatric hospital, that mixed suspected criminals with the general patient population, the report says.

The chief executive of St. Elizabeths abruptly resigned in 2016, shortly after he began work there, amid questions about his résumé, including a doctorate from an online school that lacks accreditation in the United States. In December, a forensic psychologist who evaluated hundreds of defendants for mental competence was reassigned after the Council for Court Excellence raised questions about her educational background.

Other findings from the report:

●Experience and training for psychologists and psychiatrists conducting forensic evaluations of suspects varies widely, and turnover has been high. In some instances, evaluators responsible for figuring out whether suspects could assist in their legal defenses didn’t understand basics about the legal system.

The report recommends that the D.C. Council mandate forensics training and board certifications for the evaluators. But Royster told lawmakers such requirements would make it “impossible” to hire enough staff because just a few hundred in North America currently meet those standards.

She defended the current evaluators. “It’s difficult to suddenly say people who are doing the work for many years are no longer capable,” Royster said.

●Long waiting lists for housing means patients who have a judge’s permission to leave St. Elizabeths are staying in the hospital longer than necessary — which the agency denied is a problem. And those who are found competent to stand trial are stuck in the hospital because of procedural delays.

●The report issued a harsh assessment of Johnson, who oversaw the forensic psychologists and was previously reprimanded for unprofessional conduct with patients. Staff accused her of creating a hostile work environment. Johnson referred questions to a spokeswoman for the Department of Behavioral Health, who said the report noted that formal workplace complaints against Johnson were unsubstantiated.

While Johnson is no longer in the role, the report says that the mayor should fill the job and that the position should have greater authority over spending and staff.